Patient Account Representative

Job description

POSITION GOAL
The Patient Account Representative is responsible for processing electronic and paper claims to all payers for the facility on a timely basis. Also responsible for reviewing the claims error report, audit trail errors, both electronic and paper remits and submitting corrected billings to all payers. Performs follow-up activities through the entire claims adjudication cycle.
POSITION RESPONSIBILITIES
• Processes inpatient and outpatient claims downloaded from the main frame to the electronic billing system to all payers.
• Monitors and resolves outstanding accounts receivable balances in a timely manner preventing AR aging as follows: 31-60 <=15%, 61-90 <=8%, over 90 <=12% by employing effective collection techniques, maximizing efficiency and cash collections.
• Identifies and corrects all claims that error out in the billing system prior to the claims being transmitted to third party payers.
• Identifies missing claim audits related to coding, collaborates with coding to obtain appropriate codes in order to file claims correctly.
• Processes late charges in accordance with departmental procedures.
• Responsible for working all denials via Waystar Denial Management system and updating the status weekly.
• Responsible for reporting billing, registration, posting errors/issues to the Team lead or Director.
• Reviews audit trail reports received from all payers, identifies and corrects rejected claims and resubmits to payers.
• Recommend front-end edits to be put in the electronic billing software.
• Monitors, reviews and/or responds to correspondence within 48 hours of receipt.
• Updates the patient account to reflect the current billing status with clear, detailed notes.
• Determines payment status on patient accounts using online claim status tools, voice/fax systems or via direct telephone inquiry to representatives with multiple insurance companies.
• Rejection resolution by preparation of appeal documents when claims are denied including securing medical records, preparing letters of appeal and sending needed information/documentation and/or corrections.
• Works AR and credit balance report weekly as well as maintains various reports.
• Identifies on explanation of benefits (EOB) that claim has been paid correctly, posted correctly and patient financial responsibility has been appropriately transferred in the system.
• Prepares detailed recommendations for adjustment to be made on accounts based on research and interpretation of activity on accounts.
• Reports any errors/issues to management while monitoring compliance with payer contracts and federal/state guidelines.
• Must maintain knowledge of payer contracts in order to work AR accurately.
• According to payer, completes the Medicaid Cross Over report, the Medicare Quarterly Credit Balance report and the Medicare Bad Debt report.
• Actively assist and engage in other areas of the Business Office as needed in order to achieve departmental goals.
• Meets assigned productivity of 95% or higher and quality assurance goals of 2.8 or higher.
• Demonstrate superior prioritization, organizational, and time management skills while consistently maintaining current AR balances and reducing aging accounts receivable balances over 30 days.

POSITION REQUIREMENTS
Experience:
Required:
• Good math skills and proficiency in Microsoft Applications to include Word, Excel and PowerPoint required.
• Must have exceptional customer service skills as well as verbal and non-verbal communication skills.

Preferred:
• Relevant previous billing or insurance collections experience preferred (2-4 years in health care preferred).

Education:
Required:
• High school diploma or equivalent required

Special Qualifications:
Required:
• Must have a valid driver’s license and satisfactory Motor Vehicle Record (MVR).

Preferred:
• Certified Patient Accounts Representative (CPAR) or Certified Revenue Cycle Representative (CRCR) preferred

The Hughston Clinic, The Hughston Foundation, The Hughston Surgical Center, Hughston Clinic Orthopaedics, Hughston Medical, Hughston Orthopaedics Trauma, Hughston Orthopaedics Southeast and Jack Hughston Memorial Hospital participate in E-Verify. This company is an equal opportunity employer that recruits and hires qualified candidates without regard to race, religion, color, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.